Type-2 Diabetics Treated Only With Sulfonylureas May Be at Risk

The Gist

Sulfonylureas
are a class of drugs used to increase the release of insulin from beta
cells in the body’s pancreas. They are used to treat or correct
hyperglycemia, or elevated blood sugar. They have been used successfully
since the 1950s as a single drug therapy or in combination with other
drugs to treat type-2 diabetes.

The problem with sulfonylureas is
that they can also cause side effects, including increased blood
pressure, weight gain, abdominal upset, chronic headaches, and,
according to a new study, an increased risk of heart attack, stroke, and
death.

Although the exact reason for this increased risk remains
unknown, study author Dr. Christianne Roumie, an internist with
Vanderbilt University Medical Center in Nashville, Tennessee, has been
examining the use of sulfonylureas for years. Although this most recent
study does not shed new light on why the drugs might be more harmful for
some type-2 diabetics, Roumie suggests that public health advocates
sponsor a randomized controlled trial to provide more evidence of the
cardiovascular risks associated with their use.

Physicians have been aware of the increased cardiovascular risks of sulfonylureas for roughly the past decade.

Source and Method

For
the 2012 study, Roumie’s team examined data from more than 250,000
veterans who sought treatment for type-2 diabetes and compared outcomes
for those taking only sulfonylureas versus those taking sulfonylureas
along with other drugs, such as metformin.

Though researchers
could not determine whether sulfonylureas were harmful on their own or
whether metformin acted as a preventative when the two were taken in
combination, type-2 diabetics taking sulfonylureas alone experienced a
21 percent increase in cardiac events, such as heart attack, stroke, or
death.

Other Research

A 2009 study published in the British Medical Journal
produced similar results. In that study, researchers examined more than
90,000 type-2 diabetics over a 15-year period. They found that compared
to those patients taking metformin, “monotherapy with first or
second-generation sulfonylureas was associated with a 24 to 61 percent
increase in mortality, with up to a 30 percent increase in congestive
heart failure.”

The Takeaway

As
most people understand, all drugs produce unwanted side effects. And
while most are typically minor compared to the drugs' overall benefits,
type-2 diabetes remains one of the most challenging conditions to
effectively treat. People are often lax about controlling their blood
glucose levels with diet and exercise, and many may not test their blood
sugar levels regularly.

If your doctor suggests taking a
sulfonylurea drug on its own, discuss your concerns and whether or not
your heart is healthy. Go over all of your risk factors for heart
disease, including high blood pressure, excessive weight and body mass
(especially around the waist), and if you’ve experienced chest pain.
Stress levels and whether or not you have symptoms of sleep apnea should
also be considered. Adding metformin along with your sulfonylurea drug
may be an easy—and proactive—approach to more effectively treating
type-2 diabetes.

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